Summary
Endothelial cell products, plasminogen activator inhibitor (PAI) and von Willebrand factor (vWF), were assayed in 25 patients with newly-diagnosed and untreated polymyalgia rheumatica (PMR), before and after three and 12 months of corticosteroid treatment. The mean values of PAI and vWF, and also the levels of acute phase reactants (erythrocyte sedimentation rate, fibrinogen, haptoglobin, orosomucoid, C-reactive protein) and platelet counts, were elevated in the active untreated disease. In contrast to the acute phase proteins, both PAI and vWF remained increased after three and 12 months of glucocorticoid treatment. This suggested an active vasculitis, despite a clinically-inactive disease. Particularly high levels of vWF both before and after glucocorticoid therapy were found in two patients who subsequently developed vascular complications during the follow-up period.
Similar content being viewed by others
References
Bengtsson, B.A., Malmwall, B.E. The epidemiology of giant cell arteritis including temporal arteritis and polymyalgia rheumatica. Arthritis Rheum 1981, 24, 899–904.
Persellin, S.T., Daniels, T.M., Rings, L.J., Kazmier, F.J., Bowie, E.J.W., Hunder, C.G. Factor VIII-von Willebrand factor in giant cell arteritis and polymyalgia rheumatica. Mayo Clin Proc 1985, 60, 457–462.
Sprengers, E.D., Kluft, C. Plasminogen activator inhibitors. Blood 1987, 69, 381–382.
Jaffe, E.A., Hoyer, L.W., Nachman, R.L. Synthesis of von Willebrand factor by cultured human endothelial cells. Proc Natl Acad Sci (USA) 1974, 71, 1906–1909.
Mellbring, G., Nilsson, T., Bergsdorf, N., Wallen, P. Tissue plasminogen activator concentrations in major abdominal surgery. Relationship to postoperative deep vein thrombosis. Thromb Res 1984, 36, 331–334.
Kluft, C., Verheyijen, J.H., Jie, A.F.H., Rijken, D.C., Preston, F.E., Sue-Ling, H.M., Jespersen, J., Aasen, A.O. The postoperative fibrinolytic shutdown: a rapidly reverting acute phase pattern for the fast-acting inhibitor of tissue-type plasminogen activator after trauma. Scand J Clin Lab Invest 1985, 45, 605–610.
Korninger, C., Lechner, K., Niessner, H., Gössinger, H., Kundi, M. Impaired fibrinolytic capacity predisposes for recurrence of venous thrombosis. Thromb Haemostas 1984, 52, 129–130.
Hamsten, A., Waldius, G., Szamosi, A., Blombäck, M., de Faire, U., Dahlén, G., Landou, C., Wiman, B. Plasminogen activator inhibitor in plasma: risk factor for recurrent myocardial infarction. Lancet 1987, 2, 3–9.
Awada, H., Barlowatz-Meimon, G., Dougados, M., Maisonneuve, P., Sultan, Y., Amor, B. Fibrinolysis abnormalities in systemic lupus erythematosus and their relation to vasculitis. J Lab Clin Med 1988, 111, 229–236.
Woolf, A.D., Wakerley, G., Wallington, T.B., Scott, D.G.I., Dieppe, P.A. Factor VIII related antigen in the assessment of vasculitis. Ann Rheum Dis 1987, 46, 441–447.
Belch, J.J.F., Zoma, A.A., Richards, I.M., McLaughlin, K., Forbes, C.D., Sturrock, R.D. Vascular damage and factor-VIII-related antigen in the rheumatic diseases. Rheumatol Int 1987, 7, 107–111.
Nilsson, T.K., Mellbring, G., Hedner, U. Relationship between factor XII, von Willebrand factor and postoperative deep vein thrombosis. Acta Chir Scand 1986, 152, 347–349.
Lufkin, E.G., Fass, D.N., O'Fallon, W.M., Bowie, E.J.W. Increased von Willebrand factor in diabetes mellitus. Metabolism 1979, 28, 63–66.
Jansson, J-H., Nilsson, T.K., Johnson, O. von Willebrand factor in plasma: a novel risk factor for recurrent myocardial infarction and death 1991. Submitted.
Nusinow, S.R., Federici, A.B., Zimmerman, T.S., Curd, J.G. Increased von Willebrand factor antigen in the plasma of patients with vasculitis. Arthritis Rheum 1984, 27, 1405–1410.
Byron, M.A., Allington, M.J., Chapel, H.M., Mowat, A.G., Cederholm-Williams, S.A. Indications of vascular endothelial cell dysfunction in systemic lupus erythematosus. Ann Rheum Dis 1987, 46, 741–745.
Federici, A.B., Fox, R.I., Espinoza, L.R., Zimmerman, T.S. Elevation of von Willebrand factor is independent of erythrocyte sedimentation rate and persists after glucocorticoid treatment in giant cell arteritis. Arthritis Rheum 1984, 27, 1046–1049.
Angles-Cano, E., Sultan, Y., Clauvel, J-P. Predisposing factors to thrombosis in systemic lupus erythematosus. Possible relation to endothelial cell damage. J Lab Clin Med 1979, 94, 312–322.
Bird, H.A., Esselinckx, W., Dixon, A.ST.J., Mowat, A.G., Wood, P.H.N. An evaluation of criteria for polymyalgia rheumatica. Ann Rheum Dis 1979, 38, 434–439.
Chmielewska, J., Wiman, B. Determination of tissue plasminogen activator and its fast inhibitor from plasma. Clin Chem, 1986, 32, 482–485.
Cejka, J. Enzyme immunoassay for factor VIII-related antigen. Clin Chem 1982, 28, 1356–1358.
Ciompi, M.L., Marotta, G., Pucetti, E., Remorini, E., Petrini, G., Zuccotti, M., Vispi, M., Baicchi, U., Iacconi, P. Behaviour of von Willebrand factor antigen in follow-up of polymyalgia rheumatica/giant cell arteritis. Scand J Rheumtol 1988, 17, 491–495.
Crutchley, D.J., Conanan, L.B., Maynard, J.R. Human fibroblasts produce inhibitor directed against plasminogen activator when treated with glucocorticoids Ann N Y Acad Sci 1981, 370, 609–616.
Olivi, A., Sawaya, R., Liwnicz, B. Dexamethasone modulation of fibrinoysis. In: Fibrinolysis and the Central Nervous System, Editor: Sawaya R., Hanley & Belfus, inc., Philadelphia, 1990, 294–300.
Isacson, S. Effect of prednisolone on the coagulation and fibrinolytic systems. Scand J Haematol 1970, 7, 212–216.
Aillaud, M.F., Juhan-Vague, I., Alessi, M.C., Marecal, M., Vinson, M.F., Arnaud, C., Vague, P., Collen, D. Increased PA-inhibitor levels in the postoperative period — no cause-effect relation with increased cortisol. Thromb Hemostas 1985, 54, 466–468.
Chandler, W.L., Mornin, D., Whitten, R.O., Angleton, P., Farin, F.M., Fritsche, T.R., Veith, R.C., Stratton, J.R. Insulin, cortisol and catecholamines do not regulate circadian variations in fibrinolytic activity. Thromb Res 1990, 58, 1–12.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Uddhammar, A., Rantapåå-Dahlqvist, S. & Nilsson, T.K. Plasminogen activator inhibitor and von Willebrand factor in polymyalgia rheumatica. Clin Rheumatol 11, 211–215 (1992). https://doi.org/10.1007/BF02207959
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF02207959